Radiology Teaching Files > Case 7416258

Contributed by: Bessie Itounas, Medical Student, Triton College, River Grove, IL, USA, Illinois, USA.
Patient: 52 year old male
History: 52 yr old male came in for an ultrasound due to alcoholic cirrhosis.

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Findings: Abnormal appearence of the liver consistent with history of cirrhosis with a tiny cyst but no solid masses.  Mildly distended gallbladder.  Large recanalized umbilical vein with hepatofugal blood flow.
Diagnosis: Liver cirrhosis with a tiny cyst
Recanalized Umbilical Vein
Mildly distended gallbladder
Discussion:    Hypertension develops when hepatopedal flow (toward the liver) is impeded by thrombus or tumor invasion.  The blood becomes obstructed as it passes through the liver to the hepatic veins and is diverted to collateral pathways in the upper abdomen.  The most common mechanism for increased resistance to flow occurs in patients with cirrhosis.  This disease process produces areas of micro and macro nodular regeneration, atrophy, and fatty infiltration, which makes it difficult for the blood to perfuse.

   Collateral circulation develops when the normal venous channels become obstructed.  This diverted blood flow causes embryologic channels to reopen; blood flows hepatofugally (away from the liver) and is diverted into collateral vessels.  Collateral channels may be into the gastric veins (coronary veins), esophageal veins, recanalized umbilical vein, or splenorenal, gastrorenal, retroperitoneal, hemorrhoidal, or intestinal veins. 
References: Textbook of Diagnostic Ultrasonography Volume One ( fifth edition)
Sandra L. Hagen- Ansert
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Additional Details:

Case Number: 7416258Last Updated: 12-04-2006
Anatomy: Vascular/Lymphatic   Pathology: Vascular
Modality: USExam Date: 11-27-2006Access Level: Readable by all users

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